17
Vernal/Atopic Conjunctivitis
Î General treatment measures include modifying the environment to
minimize exposure to allergens or irritants, and using cool compresses
and ocular lubricants. (III, I, D)
Î Topical and oral antihistamines and topical mast-cell stabilizers can
be useful to maintain comfort. (III, I, D)
Î For acute exacerbations of vernal/atopic conjunctivitis, topical
corticosteroids are usually necessary to control severe symptoms
and signs. (III, I, D)
Î The minimal amount of corticosteroid should be used based on patient
response and tolerance. (III, I, D)
Î Topical cyclosporine 2% is effective as adjunctive therapy to reduce
the amount of topical corticosteroid used to treat severe atopic
keratoconjunctivitis. (I-, M, D)
Î Commercially available topical cyclosporine may be a useful adjunct
in the treatment of vernal/atopic conjunctivitis. (I++, G, S)
Î For entities such as vernal keratoconjunctivitis, patients should be
informed about potential complications of corticosteroid therapy, and
general strategies to minimize corticosteroid use should be discussed.
(III, G, S)
Î For severe sight-threatening atopic keratoconjunctivitis that is not
responsive to topical therapy, systemic immunosuppression may be
warranted rarely. (I+, M, D) for tacrolimus 0.1%; (III, I, D) for all other
treatments.
Î Frequency of follow-up visits is based on the severity of disease
presentation, etiology, and treatment. (III, I, D)
Î Consultation with a dermatologist is often helpful. (III, I, D)
Î A follow-up visit should include an interval history, measurement of
visual acuity, and slit-lamp biomicroscopy. (III, I, D)
Î If corticosteroids are prescribed, baseline and periodic measurement
of IOP and pupillary dilation should be performed to evaluate for
glaucoma and cataract. (III, I, D)
